HomeMy WebLinkAbout1100 Poudre River Dr - Applications/Demolition - 01/08/2016Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application #(or7C���7 �-1 Date
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State Zip Phone
Applicant Name Address
City/State Zip Phone
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Contractor Address
City/State Zip Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ABHere ❑ Report
sales tax number isrequired byallronbactors
Are you paying with your trust account? 0 Yes ❑ No
Is this a residential or commercial project? ❑ Residential OCommerciai
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel KMedical office gOffice ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes dRJ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed? L 4 5,T
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work n e ho end ems.: el- A-e�i<S /ard•''r%s . Fl��%9s
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician (4miot R11TY,:c Plumber PP# Mechanical PP,4 Roofer
Other
I hereby acknowledge that I have read this application and state that the above information is complete and correct. I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: //�
Print Name: •4dcelli CIE191 4" Signature
Date I—